Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | ME121445 | FL |
N | 2086S0127X | Trauma Surgeon | ME121445 | FL |
NPI | 1336438704 |
---|---|
Provider Name | James David Kotick |
First Address | Augusta, GA 30914-3725 |
Second Address | Bradenton, FL 34209-4604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2011 |
Last Update Date | 18/03/2021 |